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Abortion pill reversal and the PCC

December 2015

By: Michele D. Shoun

When the abortion pill was approved for U.S. use in 2000, the pro-life movement held its collective breath. How would it change the struggle? Would abortion become so quick and easy that women no longer sought the services of pregnancy care centers?

Abortion pill dangers

The U.S. Food and Drug Administration (FDA) website notes that it “has received reports of serious adverse events, including several deaths . . . following medical abortion with mifepristone and misoprostol.” Sepsis, “a known risk related to any type of abortion, is most often associated with death from medical abortion. And “most of these women were infected with the same type of bacteria . . . Clostridium sordellii.” Their symptoms were “not the usual” ones associated with sepsis.

Providers of medical abortion are advised to “investigate the possibility of sepsis in women who are undergoing medical abortion and present with nausea, vomiting, or diarrhea and weakness with or without abdominal pain. These symptoms even without a fever may indicate a hidden infection. Strong consideration should be given to obtaining a complete blood count in these patients.” Immediate initiation of antibiotics is recommended when infection is suspected.

The FDA does not recommend the use of prophylactic (vaginal) antibiotics for women having medical abortions. Nor does it approve the vaginal administration of mifepristone or misoprostol, or the misoprotol-alone regimen. It strongly warns women against purchasing abortion drugs over the Internet.

Since then, medical abortion has made an impact, but perhaps not as great as projected. According to the Centers for Disease Control and Prevention, a little over 19% of abortions reported in 2011 were medical. “Among abortions performed at ≤8 weeks' gestation that were eligible for early medical abortion on the basis of gestational age, 28.5% were completed by this method. (See Table 11 of the CDC Surveillance Summary to learn whether your state records medical abortions and whether its percentage is higher or lower than the national average.)

• In 2011, 59% of abortion providers, or 1,023 facilities, provided one or more early medication abortions. At least 17% of providers offer only early medication abortion services.

• Medication abortion accounted for 23% of all nonhospital abortions and 36% of abortions before nine weeks’ gestation, in 2011.

• Early medication abortions have increased from 6% of all abortions in 2001 to 23% in 2011, even while the overall number of abortions continued to decline.

As of 2011, CDC reported 839,254 medical abortions, including those done during clinical trials in the 1990s. It must be noted that not all regions collect and report such data.

Why has the abortion pill not taken off as abortion advocates thought it would? Few studies have been done, but most women seem to prefer surgical abortion to medical. Drawbacks to medical abortion include the length of time it takes to complete an abortion, the uncertain result, return visits to the doctor, and more involvement required by the woman. Then there are higher rates of bleeding and cramping, the possibility surgical follow-up, and the fact women can expect to abort at home and see the remains.1

It also was not foreseen that there would be an interest in reversing an abortion once the process began.

“It may not be too late”

Pro-life doctors have developed a protocol with a 60% success rate in reversing the effects of the first pill in the two-pill abortion regimen. To date, 140 women have been able to carry babies to term after receiving the antidote for mifepristone, and another 75 are still pregnant.

How does it work?

According to AbortionPillReversal.com, women who've not yet taken the second drug (misoprostal) can be given progesterone by mouth, vaginally, or by injection. Progesterone is the natural hormone in a woman’s body that nurtures and sustains a pregnancy. Mifepristone blocks the action of progesterone by binding to progesterone receptors in the uterus and the placenta. “By giving extra progesterone, we hope to outnumber and outcompete the mifepristone in order to reverse the effects of mifepristone.”

It’s optimal to begin reversal within 24 hours of taking mifepristone, but there have been “many successful reversals when treatment was started within 72 hours.” A woman who visits the website and calls the hotline (1-877-558-0333) is connected with an on-call nurse who asks basic questions and then connects her with a doctor or medical provider in her area.

Critics suggest that, of women who take mifepristone alone, 30-50% will continue their pregnancies without intervention. They admit that progesterone is "generally well tolerated," but warn it "can cause significant cardiovascular, nervous system and endocrine adverse reactions as well as other side effects."2

For this reason, doctor supervision is recommended. It would also be helpful if doctors administering APR would carefully record results -- both of women who use APR and of women who don't but also do not take the second drug in the abortion pill regimen. More data is needed.

The PCC connection

There is now a network of 300 APR providers around the country. Some of them, like Adam Blickley, MD, are medical directors for pregnancy care centers.

Dr. Blickley has served the Pregnancy Resource Center in Grand Rapids, Michigan, the past five years. It recently implemented the abortion pill reversal (APR) protocol and has limited experience so far.

“We worked for months to coordinate a protocol with a local emergency room when a compounded injection was the only proven effective method," Dr. Blickley said. "As time is critical in starting the reversal, we wanted 24/7 availability. Hospital bureaucracy moves slowly and that never materialized. Now, however, tablets available at most any pharmacy can be used and have been shown to be just as effective. Now I am on the list of APR physicians and can be contacted at all times.”

When reached by the hotline nurse, Dr. Blickley will call the woman back as soon as possible. He takes her medical history and provides informed consent for the reversal. Then he calls in the medication prescription to her local pharmacy – one that’s open 24 hours. He starts her on two tablets placed vaginally right away, and then nightly thereafter.

He’ll ask her to visit his office for an ultrasound, further evaluation, and counseling. “Once viability and fetal age are confirmed, I continue the protocol as generally outlined. I have then made direct contact with the PRC to coordinate support and care. The woman is encouraged to go directly to the PRC, which is nearby, for emotional, spiritual and material care. Phone contact, use of resources near to her, and continued appointments are the goal.” Dr. Blickley follows the pregnancy throughout the first trimester and either proceeds with standard prenatal care or hands her off to her own physician.

He recommends APR to other PCCs. All it takes is an interested obstetrician or family physician. The protocol has been shown to be safe and effective, with backing by the American Association of ProLife Obstetricians and Gynecologists.3 He says, “The protocol depends on the age of the pregnancy but is easy and intuitive to follow. The ability to perform ultrasound and occasionally blood hormone levels are all that is required for testing.” 24/7 doctor availability is also a must, as well as follow-up care throughout the first trimester.

As with all areas of PCC, one pitfall can be loss and disappointment. In Dr. Blickley’s short time offering APR, one woman was on the way to a successful reversal but ultimately decided to terminate her pregnancy.

Jim Sprague, CEO for the Pregnancy Resource Center, is convinced abortion pill reversal is “going to be a game-changer.” He goes on to say, “As the abortion industry turns toward the easy to dispense RU-486, this last-minute turn-around option will have even more and more opportunities to be used. I see a day when it’s a service offering of every [pregnancy medical clinic].”

The PRC is making the marketing of abortion pill reversal a priority in the coming year. They want this service to show up in web searches, and have budgeted for online advertising. They also want to give local sidewalk counselors materials to hand women at the clinic, and will partner with other centers in the region who may not have a medical director. (Their first APR client lived an hour away.)

Reaching abortion-determined women has always been the PRC's "prime directive." Jim feels all the more urgent about helping women reverse the effects of RU486 since the Planned Parenthood office next door -- which never offered surgical abortions -- is now offering medical ones.